Studies indicate that access to palliative care services results in a higher quality of life for patients, better pain and symptom management, and fewer hospitalizations, which lowers healthcare costs. While the advantages of providing community-based palliative care are well documented, most health plans currently only cover services for people in hospice care, which significantly limits the number of individuals who are eligible to receive palliative care.

According to the National Academy for State Health Policy, states can improve access to high-quality palliative care by:

  • Developing standards and definitions of palliative care within the state’s licenses and regulations
  • Measuring and tracking the quality of palliative care
  • Creating Medicaid palliative care reimbursement policies
  • Building a workforce of trained palliative care providers
  • Educating patients, providers and the public about its benefits

Increasingly, states are pushing for palliative care benefits, which are changing and shifting the industry landscape.

Pre-Pandemic Legislation

In January of 2018, a California law, SB 1004, was enacted – requiring palliative care to be offered to qualifying beneficiaries from the state’s 22 Medi-Cal managed care plans (MCPs) in 58 counties. Now, MCP members with illnesses such as cancer, congestive health failure (CHF), chronic obstructive pulmonary disease (COPD) and end-stage liver disease can access palliative care services at the same time as other appropriate medical care. With this legislation, patients will no longer need to wait to prioritize their comfort and quality of life, and can reduce their pain and suffering sooner.  

Expanding Access in a COVID-19 World

A June 2021 study found that almost 25% of COVID-19 patients develop long-lasting symptoms. As a result, there are renewed discussions around providing full palliative care services in the home. The Biden administration and palliative and hospice organizations are now discussing the creation of a benefit that enables full palliative care services as a demonstration project in Medicare, with the hopes of making it a permanent for Medicare, Medicaid and commercial health plans.

Individual states have also worked on legislation regarding palliative care benefits. This June, the Illinois State Assembly passed the Pediatric Palliative Care Bill, SB.2384. The goal of this initiative is to improve access and reimbursement for community-based, interdisciplinary palliative care services, which can be leveraged at the same time as curative treatment.

In July, Hawaii, inspired by California’s success, started to pursue a Medicaid benefit for community-based palliative care. This proposed benefit would be a part of an 1115 CMS waiver, which may pave the way for other states to increase access to community-based palliative care.

As more states adopt palliative care benefits, barriers will be removed, and more people will have access to this crucial type of care.

Vynca’s board certified, physician-led palliative care team includes social workers, nurses, case managers, and chaplains. By partnering with Vynca, payers and providers are well positioned to offer more personalized care that addresses their physical, mental, spiritual and social needs while improving their quality of life.

About the Author

Michael Kersten

Michael Kersten is the Director of Partner Solutions at Vynca. Prior to Vynca, Michael worked at Hill Physicians Medical Group where he was the founding director of the complex and serious illness department.

Michael holds an MPH from UC Berkeley School of Public Health, an MDiv from Naropa University, and a BS in Biology from SUNY at Albany.